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So we are thrown back on our question: What explains our positive view of the place of surgery in baseball when we think of medicine as such a destructive presence?

I can't say for sure, but here's a hypothesis. It has nothing to do with sports or with cheating, but everything to do with our ways of thinking about ourselves.

Despite the fact that surgeons go inside your body and rebuild parts and structures, we think of them as leaving you basically unaffected. Surgeons don't change your being any more than plumbers alter the architecture. Surgery is superficial.

But when it comes to drugs, an entirely different set of intuitions kick in. Drugs are not superficial. Drugs get inside you in a deeper way; drugs change you. And so we find ourselves inclined to think that if you need drugs to be a good athlete — or if you need drugs to be happy or live without anxiety or perform sexually — then, well, you are not really a good athlete (or a happy person or a good lover). Drugs make a person inauthentic.

How hard is this to understand? TJ surgery is performed to repair damage. Now while Mark McGwire would have you believe he took steroids only to "recover faster [...] heal and prevent injuries," who thinks healthy athletes take steroids for any reason other than to perform at levels unattainable with training and exercise alone? To compare illnesses like depression, anxiety and impotence to athletic aspiration is simple minded, at best IMO.

How hard is this to understand? TJ surgery is performed to repair damage. Now while Mark McGwire would have you believe he took steroids only to "recover faster [...] heal and prevent injuries," who thinks healthy athletes take steroids for any reason other than to perform at levels unattainable with training and exercise alone?

The distinction isn't as clear-cut as you seem to think. Steroids aren't magic instant-muscle drugs. Rather, one of the main things they do is speed recovery time from the muscle damage caused by exercise, thereby allowing more frequent and harder workouts.

Pitchers who use steroids by and large aren't looking to bulk up, but rather to benefit from speedier repair of the damage caused by the unnatural act of pitching a baseball. Why is taking a drug that facilitates recovery from "ordinary" wear and tear seen by so many as morally wrong whereas having a tendon implanted in your arm to repair a catastrophic injury seen as perfectly OK? Surgery is hardly risk-free, and my sense is that a lot of people would still object to steroids and other PEDs even if they were entirely safe.

This seems like question worth exploring (which is the author's point), since it isn't immediately apparent (to me, at least) that the intuitive response so many people have on this issue necessarily has a coherent and principled underpinning.

What you've just said is one of the most insanely idiotic things I have ever heard. At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul.

How hard is this to understand? TJ surgery is performed to repair damage. Now while Mark McGwire would have you believe he took steroids only to "recover faster [...] heal and prevent injuries," who thinks healthy athletes take steroids for any reason other than to perform at levels unattainable with training and exercise alone?

The "to repair damage" argument is popular, but essentially arbitrary. We know that players *do* take steroids and "PEDs" to recover from injury. (CF Andy Pettitte, etc.) We also know they take supplements to aid training routines (the primary goal of which is to aid muscle recovery after heavy workouts - that's what PEDs do "in the gym.") I think the article gets at the nub of the thing when it talks about how we internalize our notions of self and intuitions of "change." We have this silly notion that HGH changes players into some sort of techno-Frankenstein's monster, while cutting out the ligament of a dead man and inserting into a player's knee is "repairing damage" and merely resetting the status quo.

It's fundamentally arbitrary and, contra Ivan @1, stupid.

(If you don't like the TJ surgery angle, ask the exact same question about Lasik eye surgery, which any number of players have in order to see better than they were naturally born able to see.)

Pitchers who use steroids by and large aren't looking to bulk up, but rather to benefit from speedier repair of the damage caused by the unnatural act of pitching a baseball.

Pitchers who use steroids intend to cheat. They are looking to gain an "unnatural" advantage over their competitors, ie the subset of human beings who all perform the unnatural act of pitching a baseball, who also work out but who do not want to inject themselves with hormones. The above statement is exactly the McGwire excuse but applied to pitchers.

Why is taking a drug that facilitates recovery from "ordinary" wear and tear seen by so many as morally wrong whereas having a tendon implanted in your arm to repair a catastrophic injury seen as perfectly OK?

The attempt to downplay the intended use of steroids as mere "recovery from 'ordinary' wear and tear" is belied by the acknowledgment that steroids are actually used to exceed ordinary effort and avoid the resultant damage by enabling "more frequent and harder workouts" than would be possible without steroids.

Is steroid use justified in that it may enable the noble goal of working harder than one's competitors?

(Obviously not everyone who has a long pitching career gets Tommy John surgery, nor does everyone who gets Tommy John surgery have a long pitching career.)

How hard is this to understand? TJ surgery is performed to repair damage.

While doing baseball clinics on Long Island, I have been approached by parents who want to get voluntary Tommy John treatment for their son the pitcher is hurt in order to re-tighten the ligaments and add velocity to hopefully get a college scholarship.

They "intend to cheat" only because using steroids is now against the rules. That doesn't address the question of why the rules prohibit injecting steroids but not having a tendon surgically implanted in your arm to replace a torn ligament.

They are looking to gain an "unnatural" advantage over their competitors, ie the subset of human beings who all perform the unnatural act of pitching a baseball, who also work out but who do not want to inject themselves with hormones.

A pitcher who has TJ surgery also gains an "unnatural" advantage over his competitors with torn UCLs who do not want to subject themselves to surgery. You still haven't convincingly articulated a reason why taking drugs is fundamentally different.

The attempt to downplay the intended use of steroids as mere "recovery from 'ordinary' wear and tear" is belied by the acknowledgment that steroids are actually used to exceed ordinary effort and avoid the resultant damage by enabling "more frequent and harder workouts" than would be possible without steroids.

Is steroid use justified in that it may enable the noble goal of working harder than one's competitors?

You're sidestepping the question raised by TFA. Other things that enable people to work harder than their competitors aren't seen as wrongful. What is it about using drugs that is different?

What you've just said is one of the most insanely idiotic things I have ever heard. At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul.

OK, so it is me and the professor of philosophy from Berkeley vs. a guy on the internet who likes to quote Adam Sandler movies. Strangely, I'm not quaking in my intellectual boots.

I think the article actually does a decent job of tackling a topic that pointy-headed historians, sociologists, and philosophers of science, medicine, and technology spend entire lives trying to figure out: how do humans draw boundaries between the "natural" and the "artificial."

The author isn't wrong for pointing out that there isn't a tidy division between medical interventions that are natural and ones that are some sort of affront to the laws of god, nature, and morality. To go on a bit of a tangent, is aspirin any less natural in capsule form than if we were still getting it straight from the willow bark? What is it that makes natural gas any more natural than oil? What the hell does "All Natural" labeling have to do with something that comes packaged in plastic and advertised with flashy ink printed on a post-consumer waste recycled cardboard box?

These are parlor-game sort of questions that quickly can become tedious bores, but also are useful exercises in reminding us that ultimately, we and not "nature" get to choose what's natural and what's unnatural. I am not a medical expert, but I would be curious to hear an explanation of why a cortisone shot, an injection of corticosteroids, are any more natural and moral of a medical intervention than guzzling down bull testosterone.

BP: Speaking of getting back to where you were before and getting back to elbows, we've heard from quite a few pitchers, swearing they throw harder after Tommy John surgery than they did before. Is this possible?

FJ: When a pitcher comes in with elbow problems, you often see that their ligaments were already wearing out well before. Maybe four or five years ago they could throw a 95 mile an hour fastball, but they've had that ability diminished as the ligament's been stretched. What the surgery does is restore the ligament's stability to where it was four or five years ago. A pitcher might say the operation did it, but it's just more stability in the arm contributing to better mechanics.

BP: Would a pitcher ever consider getting elective Tommy John surgery, just hoping to get that fastball?

FJ: It wouldn't help if you didn't have it before. All the surgery does is get you back to your normal elbow. You either have the stuff or you don't. A player that reaches the majors, he's spent years in the minors improving, making his mechanics better, with his muscles getting stronger.

One thing we did see though, after we did this on Tommy. A person who's a pitcher might come in, someone who's not in the majors. And we'll ask him: Do you really want to be a pitcher? Is this your life's goal? Because it's going to take at least a year of your life to get back. [Emphasis added]

http://assets.espn.go.com/mlb/columns/bp/1431308.html

The thread where it was originally posted at BBTF: (http://www.baseballthinkfactory.org/newsstand/discussion/espncom_mlb_interview_with_dr_frank_jobe)

The attempt to downplay the intended use of steroids as mere "recovery from 'ordinary' wear and tear" is belied by the acknowledgment that steroids are actually used to exceed ordinary effort and avoid the resultant damage by enabling "more frequent and harder workouts" than would be possible without steroids.

Is steroid use justified in that it may enable the noble goal of working harder than one's competitors?

You're sidestepping the question raised by TFA. Other things that enable people to work harder than their competitors aren't seen as wrongful. What is it about using drugs that is different?

The benefit of Tommy John surgery is clear - to restore the elbow to what it was. If essentially healthy people were undergoing elective "enhanced" Tommy John surgery--call it Nolan Ryan surgery--that had the effect of adding 5 mph to their fastball which said people could not otherwise attain merely by workouts, etc., that would also be wrong.

It is the athlete's intent--to heal or to gain advantage from something other than hard work alone--and not the form of therapy delivery--surgery or drugs--that matters here to me.

If the benefit of steroids were merely to heal and to restore the muscle to what it was, that would be one thing. But these drugs, which are not your hypothetical or putative harmless steroids that do not have enhancing effects or adverse hormonal, etc. side effects, are intended to do more than merely restore the muscle to what it was by enabling "more frequent and harder workouts".

Or are you the only person who believed McGwire's self-serving statement about his using steroids merely to try to get off the DL and not to hit more and longer home runs?

OK, so it is me and the professor of philosophy from Berkeley vs. a guy on the internet who likes to quote Adam Sandler movies. Strangely, I'm not quaking in my intellectual boots.

Well considering neither you (another random guy on the internet), or the esteemed professor of 'couldn't be bothered to study real science', have so far failed to come up with the obvious difference, maybe I am not the one who needs to retie my intellectual bootlaces.

But to spell it out for you: TJ surgery, and LASIK for that matter, is a procedure which does not simply improve athletic performance, it improves quality of life in general. Somehow, tons of non-athletes have come to the conclusion, that having a functioning ligament, or eyes that can see shit, is a net positive, and have elected to have those performed, even though they have no athletic aspirations whatsoever. This is generally speaking the same reason we let athletes get TUEs for drugs that doctors think will improve their lives (even if amphetamines are over-prescribed).

Contrast that with anabolic steroids, which rarely have a use outside of athletic endeavors (corticosteroids are the medically useful ones), and doctors generally refuse to prescribe for a reason (good luck getting a TUE). And additionally they have a ton of side effects, which can indeed lower the quality of life, instead of improving it like TJ or LASIK. And to top it all off, allowing them places a burden on those who do not wish to incur those negative side effects, to either potentially sacrifice their, or lose out on their job, or take a lower salary.

That supposedly intelligent people are somehow flustered as to why those to things are treated differently seems weird. But if you want to come up with an analogous surgery to steroids, you need to come up with an example that is more comparable than the ones you have. How about athletes surgically removing their spleens, in order to reduce their body weight? If you bother to ask the right question, you will easily see that the division isn't between drugs and surgery. And that people are ok with some drugs in some circumstances, but not in others, and some surgeries in some circumstances, but not in others. Weird that.

First of all, I think intelligence bell curves overlap enough that the best thing Adam Sandler ever wrote, which is quoted in #4, should be treated with the same respect as a typical remark by a reasonably smart person...

If essentially healthy people were undergoing elective "enhanced" Tommy John surgery--call it Nolan Ryan surgery--that had the effect of adding 5 mph to their fastball which said people could not otherwise attain merely by workouts, etc., that would also be wrong.

It would be interesting to see how baseball would react to that. It will also be interesting to see how it reacts to genetic manipulation towards the same end, which is very likely to happen at some point.

I do think the article, although it takes its thesis too far, is at least correct that phrasing something as "surgery" makes it sound medically necessary in a way that phrasing it some other way doesn't. I am less sure that baseball would ban "Nolan Ryan surgery" than I am that they would ban genetic manipulation. I don't think that we know for sure how either one would play out, though.

Personally, I would have no problem with "Nolan Ryan surgery" as long as there were no negative side effects. My objection to steroids is that I don't want players in a position where they have to either take a harmful drug or lose their job.

While doing baseball clinics on Long Island, I have been approached by parents who want to get voluntary Tommy John treatment for their son the pitcher is hurt in order to re-tighten the ligaments and add velocity to hopefully get a college scholarship.

"allowing them places a burden on those who do not wish to incur those negative side effects, to either potentially sacrifice their, or lose out on their job, or take a lower salary."

someone should email the author this point, which I and others seem to keep having to make.

my anticipated response from him:

"Oh."

I realize I missed a "health" in that original statement after "sacrifice their". Too late to edit, "mea culpa".

in general, and the reason I initially responded with snark, is that the point is such an obvious difference between TJ and steroids, and has been made so often, that I simply assume anyone who pretends not to see it, is simply engaging in intellectually dishonest argumentation.

There's additionally the factor that the existence of TJ surgery almost certainly leads to more abuse of pitchers' arms. If you can fix the problem once it occurs, there no particular reason to go out of your way to avoid causing the damage in the first place.

#15 -- thank you for actually addressing the argument rather than engaging in "nyah you're stupid" ad hominem attacks. It is a refreshing change.

But to spell it out for you: TJ surgery, and LASIK for that matter, is a procedure which does not simply improve athletic performance, it improves quality of life in general. Somehow, tons of non-athletes have come to the conclusion, that having a functioning ligament, or eyes that can see ####, is a net positive, and have elected to have those performed, even though they have no athletic aspirations whatsoever.

That is true of LASIK, but not of TJ surgery. Few people get TJ surgery merely to "improve quality of life in general". From WebMD:

Only rarely do UCL injuries interfere with non-throwing activities, such as:
activities of daily living

The vast majority of people who get TJ surgery are athletes looking to resume their athletic careers.

Contrast that with anabolic steroids, which rarely have a use outside of athletic endeavors (corticosteroids are the medically useful ones), and doctors generally refuse to prescribe for a reason (good luck getting a TUE). And additionally they have a ton of side effects, which can indeed lower the quality of life, instead of improving it like TJ or LASIK. And to top it all off, allowing them places a burden on those who do not wish to incur those negative side effects, to either potentially sacrifice their, or lose out on their job, or take a lower salary.

Those are indeed some of the arguments that can be made once you actually engage in the author's project of trying to articulate a basis for the distinction rather than merely sneering at the enterprise. I'm well aware of them (and actually find some of them fairly persuasive, mainly the safety/burden argument).

However, even the safety argument isn't as clear-cut as you make it out. TJ surgery requires general anaesthesia, which is a lot safer than it once was but still not entirely risk-free. We evidently consider the risk sufficiently low to be tolerable, but where is the cut-off point?

More fundamentally, even if the risks associated with steroid use could be reduced to this same level through medical supervision or some new drug that produces the same results without the side-effects, many people would still consider it wrongful. (Indeed, WADA bans drugs like pseudoephedrine hydrochloride for their performance enhancing quality even though they are safe enough to be sold over the counter.) The author is trying to unpack this reaction and figure out the underlying reason for it. I think this is an interesting question. You evidently don't. That's great, but don't make the mistake of assuming that those who don't see the answer as obvious haven't thought the question through.

Pitchers who use steroids intend to cheat. They are looking to gain an "unnatural" advantage over their competitors,

And since we can perfectly read the minds of a large group of strangers and find they all think in unison, I also sense they intend to order an iced Frappuccino after their workout.

Clearly they never do it because their competitors are already doing it. And they never do it to deal with the pain & wear and tear of their daily pitching existence. But they all agree that the Blonde 3 rows back behind the bullpen has amazing knockers.

But to spell it out for you: TJ surgery, and LASIK for that matter, is a procedure which does not simply improve athletic performance, it improves quality of life in general.

I've noticed that being more physically fit from frequent workouts has no general life benefits. Every time those guys flex their big biceps or flash their six pack abs women run screaming in horror.

And additionally they have a ton of side effects, which can indeed lower the quality of life, instead of improving it like TJ or LASIK.

Little known fact: No TJ surgery has ever failed, and no-one ever ended up worse off because surgery never has side effects or complications. And LASIK is perfect, unless you have to have it performed 3 days in a row on the same eye until your eyeball feels like it's been scraped with a red hot razor, and your vision ends up being murky because of the degradation. But I must have imagined that (did I type "imagined" or "experienced" it's hard to tell through my wrinkled cornea).

it's like this - best i can tell the hate of steroids is because the person gets physically larger

i can see a really good player refusing to go near roids early in his healty career and then as the injuries and soreness pile up with aging, to look to them to restore what used to be.

the reason they can't be used by TEAM doctors to aid recovery from sprains/injuries is, what, not everyone can have them or needs them? they wouldn't hesitate to shoot up every player on the team with cortisone, so why is this particular stuff view with such shudders?

and if a player does anything whatsoever to recover from injury, how is that "natural?" BITGOD you got injured, tore up your shoulder, your elbow, your knee, then you were basically finished as a ballplayer, with very few exceptions.

so now, guys are continuing their careers, padding their stats, when 80 years ago, they couldn't. poor jimmie foxx. why isn't continuing to play when you otherwise couldn't not considered with the same HORROR TEH RECORDS/STATS!!!!!

how is restoring a 30 year old's elbow to what it was when he was 25 "natural"? how is this not giving him a competetive advantage against 30 year olds whose ligaments are frayed but not broken and those guys aren't what they once were?

i guess it doesn't matter because they are not physically larger

and of course, it is hardly cheating to change your vision from 20/20 to 20/10 with unnatural surgery - making you better than you could "naturally" be

it's all about the home runs

which is why no one is screaming to delete the stats of freddy galvis (who neglected to wear a condom and got, um, popped) or matt lawton who are just as much drug cheats as wally joyner, or FP santangelo or JC romero or
um
uh
i forget their names

in general, and the reason I initially responded with snark, is that the point is such an obvious difference between TJ and steroids, and has been made so often, that I simply assume anyone who pretends not to see it, is simply engaging in intellectually dishonest argumentation.

I think there are just a lot of people who just haven't thought about it much, and haven't had the nuanced discussions of it that have been going on here for 10 or so years.

There might be an interesting surgery v pharmacologic debate to be found, although the current surgical options aren't quite comparable to steroids yet, so it's not very pressing. I think the more thorny questions would be about future technologies, like eye surgeries that could improve someone's vision to better than 20-20, or at least better than they would "naturally" be. Or if there were some surgical implant that could make your nervous system work more quickly.

Another problem with comparing surgeries to drugs is that while surgery can have a dramatic effect on one small area of the body, baseball requires a complex and finely tuned series of body mechanics such that tweaking just one piece generally won't have a huge effect (unless it's to fix damage). Pitching and hitting mechanics are incredibly complicated and involve the entire body rather than just one muscle or joint, an having just one "supercharged" part in that enormously complex system seems unlikely to make a dramatic difference. You're always going to be held back by your weakest link. Pharmacologic agents can have system-wide effects throughout the whole body, however, so it seems like they'd be tough to beat in terms of improving the mechanical skills that would effect baseball.

I think the more thorny questions would be about future technologies, like eye surgeries that could improve someone's vision to better than 20-20, or at least better than they would "naturally" be.

Lasik surgery is already capable of doing that. When I got mine in 2000, my vision went from an astigmatic 20/200 to 20/15, which I'd never had previously. It's since regressed to around 20/25, but then I'm not the age of a Major League ballplayer. Any ballplayer who wanted to improve his vision beyond 20/20 is perfectly free to do so today, though whether or not it would make that much difference is an open question. Ted Williams had a lot more going for him than his 20/10 vision.

well we all know that 20/10 vision is not exactly all you need to hit like ted. or even uecker.

but that sin't the point - the point is that the objection to steroids is that it makes the ballplayer (supposedly) better than he would be if he didn't use, and this is a terrible thing

but making your eyesight better than it ever was at any time in a ballplayer's life, better than "normal" is somehow NOT cheating

i would love it if some guy got lasik surgery so he could see 20/10 or even 20/5, when he never had better vision than the normal 20/20, then broke the HR record and stated that it was all due to the eye surgery (assuming he had drug tests 4 times a day 24/7/365 so everyone can know it wasn't drugs)

Lasik surgery is already capable of doing that. When I got mine in 2000, my vision went from an astigmatic 20/200 to 20/15, which I'd never had previously. It's since regressed to around 20/25, but then I'm not the age of a Major League ballplayer. Any ballplayer who wanted to improve his vision beyond 20/20 is perfectly free to do so today, though whether or not it would make that much difference is an open question. Ted Williams had a lot more going for him than his 20/10 vision.

Damn, is it that good? I really need to look into that.

I gotta think it would make a difference, right? All other baseball skills being equal? Picking up spin on a pitched ball seems like it would be incredibly helpful (assuming you had the skills to react to the spin on that ball successfully, of course).

So that seems like players would be compelled to get the surgery in a similar way to doing steroids, to me. I think that's where the debate should be, although Lasik seems kind of boring so maybe it's not a very interesting debate.

I think there are just a lot of people who just haven't thought about it much, and haven't had the nuanced discussions of it that have been going on here for 10 or so years.

So how often do you roll out of bed, and knock out a few thousand words for an article, without giving the subject matter much though? I am not sure that makes the person look better than assuming intellectual dishonesty...

There might be an interesting surgery v pharmacologic debate to be found, although the current surgical options aren't quite comparable to steroids yet, so it's not very pressing.

I do think there is a significant cause that you are missing, which is responsible for having to reach (like I did with my spleen example*) to find surgical options that are analogous to steroids. Doctors generally are just not going to perform dodgy surgeries where the risk/reward structure is off.
It's also why the cries of 'but surgeries can have bad outcomes too' (see posts #23/23) are hollow. The negative side effects for drugs don't go away just because somebody with some letters in front of his name writes out a prescription. But there's a trained expert making a risk/reward calculation, and coming to the conclusion that the patient is better off with, than without. For surgeries that is built in.

I do think there is a significant cause that you are missing, which is responsible for having to reach (like I did with my spleen example*) to find surgical options that are analogous to steroids.

No one is saying Lasik surgery is the same thing as steroids, but I think it's hard to deny that there are significant similarities between the two. Moreover, the similarities contain many of the problems that make steroids such a scourge: Lasik can be dangerous, too, and it can improve a player's physical skills beyond what he "normally" has. The biggest difference is that one is widely accepted and one isn't, but that just brings us back to the question of why that is.

There are significant differences between anabolic steroids and hGH, too, but for some reason, they're lumped together under the rubric of PEDs and treated as if they are exactly the same.

On the spectrum from Tommy John surgery -> Lasik -> Adderall -> amphetamines -> hGH -> anabolic steroids, it's not at all clear to me that a bright line should be drawn anywhere. Obviously, though, it's drawn right before you get to hGH. But I have yet to hear a compelling reason why it should be put there and not anywhere else.

So how often do you roll out of bed, and knock out a few thousand words for an article, without giving the subject matter much though? I am not sure that makes the person look better than assuming intellectual dishonesty...

Are you serious? Have you read sportswriters in the MVP and HoF debates?? I guess you could argue those guys are mostly intellectually dishonest. In terms of actual serious people, you do actually see this in academia every so often. When people who know about one discipline try to cross over to another, they are often ignorant of the debates that have been going on in that field for decades. Sometimes that can result in an interesting, fresh take on a subject, but other times (probably most) it comes off poorly. Linus Pauling might be a good example of this. Or when particle physicists try to weigh in on climate change or something.

I do think there is a significant cause that you are missing, which is responsible for having to reach (like I did with my spleen example*) to find surgical options that are analogous to steroids. Doctors generally are just not going to perform dodgy surgeries where the risk/reward structure is off.
It's also why the cries of 'but surgeries can have bad outcomes too' (see posts #23/23) are hollow. The negative side effects for drugs don't go away just because somebody with some letters in front of his name writes out a prescription. But there's a trained expert making a risk/reward calculation, and coming to the conclusion that the patient is better off with, than without. For surgeries that is built in.

Oh, there's totally a risk/reward or risk/benefit calculation. I hope I didn't give the impression that my comments were intended to be the only viable arguments. Surgeries generally aren't developed unless physicians think they're going to be medically necessary, and it's usually a lot harder and more permanent to develop a surgery than develop a drug, so there are going to be greater barriers to developing a steroid-like medically unnecessary surgery. I'm not sure risk/reward is that exact and quantifiable a process, though. Calculation of risk/benefit is probably a misleading term, because it implies a degree of numerical certainty that doesn't exist in how those decisions are often made. I mean, we still spend a tremendous amount of money on back surgeries that don't have a lot of evidence of benefit. The difference is that a critical mass of physicians sincerely believe that those are beneficial, despite the highly mixed evidence. Different physicians could reasonably come to very different conclusions based on the perceived risks and benefits, though. A lot of stuff is still just based on tradition and not-fully-tested theory.

Some of this argument has to do with how we view illness and how we train physicians, too. Physicians are generally trained to treat pathology. They fix problems. Human health is usually seen as the lack of problems. Any drug or procedure done on an otherwise "healthy" person is often considered at best wasteful and at worst harmful. I think that's a reasonable position to take (I'm pretty deeply entrenched in the medical community), but it does affect the risk/benefit calculus, moving it closer to doing nothing.

On the spectrum from Tommy John surgery -> Lasik -> Adderall -> amphetamines -> hGH -> anabolic steroids, it's not at all clear to me that a bright line should be drawn anywhere. Obviously, though, it's drawn right before you get to hGH.

Well a) AFAIK Adderall is an amphetamine.
b) There really is no line. If you can get the medical panel to write you out a TUE for anabolic steroids, you can use them as freely as you can amphetamines. And if you can't get one for amphetamines and get busted using them you are still screwed. The line is purely your imagination.

It is, and players know it. Both Tony Gwynn and Greg Maddux had Lasik surgery late in their careers, not because they were going blind and couldn't read to their kids, but because it improved their degrading baseball skills such that they could compete at a high level (and keep some other player out of MLB while they hung around) for a few more years.

The argument that HGH use means a guy who is unwilling to use might lose his spot in MLB is true, but less than compelling. That is also true of the guy who isn't willing to put in the rehab work after surgery, or the guy that isn't willing to toil away in the minors waiting for his shot, or the guy that's not willing to put the rest of his teenage life on hold while he plays baseball season in and season out from the time he's 8 years old and people start to recognize that he's better than the other little leaguers.

Every player makes choices about what they are willing to commit to and what they're not willing to do in order to play MLB. Are you willing to move from your posh suburban CA home to play in crap rookie ball in the Appalachian League, or would you prefer to go to UCLA and enjoy the coed lifestyle? Life is a sequence of choices, and pretending that "OH MUR GAH, PEDS!" is some sort of unique or different kind of choice is silly.

As to Lasik, I know a pro-golfer who won a tournament on the PGA tour who had it (Ian Leggatt - golfed at the same course as my family did), but it wasn't perfect and suddenly he had double vision and couldn't putt worth a darn. I think it was 3 more surgeries that were needed before he had decent vision again and his pro career was pretty much over. He now is an announcer but you think he doesn't regret getting that surgery? Side effect and permanent damage can happen when you get any surgery and can be more devastating to a pro-athletes career than most PED's can.

I'm certain that within a few years, if not already, there are surgeries that can enhance a player (the artificial legs used by Para-Olympic runners being a case in point as they banned those runners for awhile from regular competition). I'm certain also that it will be very hard to ban those after Tommy John surgery was fully accepted. I figure in 30-50 years (after stuff like this becomes common) people will look back and wonder what the fuss was all about with PED's much like we wonder about the fuss the Olympics used to make about 'pro' vs 'amateur'.

As to Lasik, I know a pro-golfer who won a tournament on the PGA tour who had it (Ian Leggatt - golfed at the same course as my family did), but it wasn't perfect and suddenly he had double vision and couldn't putt worth a darn. I think it was 3 more surgeries that were needed before he had decent vision again and his pro career was pretty much over. He now is an announcer but you think he doesn't regret getting that surgery? Side effect and permanent damage can happen when you get any surgery and can be more devastating to a pro-athletes career than most PED's can.

OTOH Tiger got his Lasik in 1998 or 1999 and has never had any subsequent problems. I got my surgery from the same doctor, and that may explain why I've never had any problems, either. OTOH I'd be very wary of some of these "discount" Lasik centers that offer you prices as low as $500 or $1000 per eye.

If essentially healthy people were undergoing elective "enhanced" Tommy John surgery--call it Nolan Ryan surgery--that had the effect of adding 5 mph to their fastball which said people could not otherwise attain merely by workouts, etc., that would also be wrong.

Why don't more people try the Three-Finger Brown surgery? Would it be wrong if it worked?

Agree with baseballchick it's all about the home runs. It's hard to find a PED article that doesn't discuss Bonds and McGwire and Sosa.
With better surgeries, Mays or Mantle or McCovey might have held home run records.
As for the risk of surgery compared to PEDs, one of the consequences of Bonds' almost annual knee tune-ups was the infection that made him miss most of 2005 and was reported to be life-threatening. That surgery was probably only recommended because he wanted to play baseball at a high level, not because he wanted to do normal activities. So he submitted to a health risk to play baseball.
The PEDs that Biogenesis were apparently the troches prescribed for low-T and advertised as much as beer on athletics events - Cenegenics hawks them nationwide in advertisements and they've been featured on the Today show and in the Wall Street Journal. These are not the liver-toxic oral anabolic steroids of the 70s. They are meant to promote overall well-being and probably the only risk is that they may trigger feedback mechanisms that it may suppress the player's production of his own testosterone. This stuff almost certainly has less risk than surgery - that is if you're not purchasing it on the internet from PEDunlimited.com and then the risk is not due to the drug treatment.

So where does platelet-rich plasma therapy fit in to this argument? On the surface, it seems like half-PED, half-surgical procedure. And yet it's been accepted by the baseball establishment and the MSM with barely a peep.

I'm certain that within a few years, if not already, there are surgeries that can enhance a player (the artificial legs used by Para-Olympic runners being a case in point as they banned those runners for awhile from regular competition). I'm certain also that it will be very hard to ban those after Tommy John surgery was fully accepted. I figure in 30-50 years (after stuff like this becomes common) people will look back and wonder what the fuss was all about with PED's much like we wonder about the fuss the Olympics used to make about 'pro' vs 'amateur'.

It's hardly a long-term science fiction scenario. It's a "within this decade" scenario. What happens when someone develops a synthetic ligament that does what a normal ligament does, attaches with the same rate of success, and increases your fastball by 10 MPH? What happens when a guy that sits at 92-94 with movement pops his elbow and needs "Tommy John" surgery, but instead of having them go into his knee to get the "extra" ligament, they opt to put that synthetic ligament in? 18 months later he's back sitting at 98-101 with the same movement? Is that "performance enhancement" or just a guy having surgery to "repair" himself?

What about a pitcher who is diabetic and requires an insulin pump (there was a guy on the Braves who had this issue a few years back.) His "natural performance level" is pretty much sitting on the couch trying not to die. But drop a bio-mechanical insulin pump in his gut... Major League reliever!

Again, to pretend there's some sort of bright line here where "PEDs" are even and bad and TJ surgery or Lasik or whatnot is fine is to be mindless and thoughtless about the issues at hand.

But to spell it out for you: TJ surgery, and LASIK for that matter, is a procedure which does not simply improve athletic performance, it improves quality of life in general. Somehow, tons of non-athletes have come to the conclusion, that having a functioning ligament, or eyes that can see ####, is a net positive, and have elected to have those performed, even though they have no athletic aspirations whatsoever.

Contrast that with anabolic steroids, which rarely have a use outside of athletic endeavors

Are you being intellectually dishonest, lying or just ignorant?

Anti-aging clinics dole this stuff out by the bucketful. Bosch's other clients were 40-year-old office workers who wanted to feel and look like they were 25-30. They were injecting themselves with steroids, IGF-1 and all the rest. There's not a gym in the world that doesn't have a couple of guys walking around that make Bonds look like Pee Wee Herman. The amount of plastic surgery going on for no good reason is criminal.

Hell, at least one out of three ads on Primer is about looking better.

As noted by another poster, TJS has virtually no non-athletic applications. Rather than being morally troubling, that should be comforting to us -- at least we aren't asking these guys to risk long-term impairment for our enjoyment. (Not so sure about torn labrums.)

I always bring up that near the end of his career, Clemens was using Vioxx to kill the pain so he could take the mound every 5th day. In no way, shape or form is that "natural." Clemens's body was no longer capable of pitching 5+ innings every 5th day without drugs. That obviously has the same moral implications as PED use -- enhanced performance, health side effects, taking somebody's job away, putting pressure on others to keep up (have people never seen N Dallas 40?).

So it's a completely arbitrary and illogical line in the sand that some try to draw. Taking your natural body, enhancing it through drugs and surgery so that it performs at an undefined and unknown "normal" level that might have been theoretically possible in a world where bodies don't age and degrade is OK; taking your natural body, enhancing it through drugs so that it possibly performs at an undefined and unknown "beyond normal" level that might have still been theoretically possible through "natural" workouts alone is not OK.

Yep, couldn't be more clear.

Now, can someone explain to me why Bartolo Colon was suspended last year? His ERA+ was in line with his career norms, his K-rate was way below his career norms and even a smidgen below his 2009 K-rate and 2 full Ks below his 2011 rate, his H/9 rate was above his career norm. He was not a better pitcher than his "natural" state. Clearly whatever he used was at best "restorative". So as I understand it, we're all OK with that.

On LASIK: In what way does this improve quality of life? What percentage of people "need" LASIK surgery as opposed to people getting it because they think they look dorky in glasses? How many people "need" vision correction beyond that required for driving and/or reading which can pretty much always be achieved by glasses/contacts?

Why don't more people try the Three-Finger Brown surgery? Would it be wrong if it worked?

Not quite the same, but NFL Hall of Famer Ronnie Lott had the tip of his injured finger amputated rather than go through a bone graft that would have preserved his finger but would have meant missing part of the next season.

On LASIK: In what way does this improve quality of life? What percentage of people "need" LASIK surgery as opposed to people getting it because they think they look dorky in glasses? How many people "need" vision correction beyond that required for driving and/or reading which can pretty much always be achieved by glasses/contacts?

I needed LASIK so I could pick up hot girls in bars, (what greater life quality improvement could there ever be) and clear it can't be done without LASIK.

First, I needed to be able to see well enough to tell which girls were hot or not.

Second, I needed to get rid of the glasses because I've been told all my life that hot girls don't like guys who wear glasses (See Kent, Clarke).

Finally all is left is to establish that hot girls want to be picked up in bars by me. I haven't tested that yet, as it's only been 10 years since my LASIK and given that my throat is frequently dry when hot girls are around I'm just waiting for the right moment.

But if you want to come up with an analogous surgery to steroids, you need to come up with an example that is more comparable than the ones you have. How about athletes surgically removing their spleens, in order to reduce their body weight?

How about athletes surgically removing their hamate bones in order to swing a bat better?

On LASIK: In what way does this improve quality of life? What percentage of people "need" LASIK surgery as opposed to people getting it because they think they look dorky in glasses? How many people "need" vision correction beyond that required for driving and/or reading which can pretty much always be achieved by glasses/contacts?

This seems like a very dumb and short-sighted question. (Yes, I saw what I did there.) I knew a girl from college who finally got LASIK in her late 20s and it improved her getting around when she went to bed and got up in the morning so she wouldn't trip and whack her legs into things. She broke her toe once that way. It helped her see in the rain while she was riding her bike, it helped her see in the rain better, period. Her eyes were too bad for contacts (of the late 90s) so it helped reduce the glare on her eyes as she could finally wear sunglasses. There are a myriad of needs it fulfills to improve the quality of your life. It's like asking if you need indoor plumbing. You can certainly go out and shit and piss in the yard, or in a group bathroom in the tenement, but WTF would you do that now when technology exists to make you life better?

Lastly, she made a point to tell me it made her happier because she - like any normal human - didn't want to #### while wearing her glasses, and finally everything wasn't a dull blur while she was having sex.

Jose Canseco disagrees with you. Unlike McGwire who was a workout fanatic, Canseco said he never worked out at all and got bigger and stronger anyways just from taking the steroids alone. Not that he's correct, necessarily, but a lot of people seem to think he's right about this, thus their attitudes towards steroids.

I gotta think it would make a difference, right? All other baseball skills being equal? Picking up spin on a pitched ball seems like it would be incredibly helpful (assuming you had the skills to react to the spin on that ball successfully, of course).

Actually, Ted Williams was quite amazed because, according to Ted, Stan Musial could do exactly that. As soon as a pitch left the pitcher's hand Stan would say "fast ball" or "curve" or "slider" because apparently Musial could immediately read the spin and identify the pitch.

Now Musial doesn't seem so impressive. He knew what pitches were coming and he still "only" hit .331 lifetime?

In many, many ways. I could never stand wearing contacts and always had glasses. A list of some of my improvements since getting Lasik six years ago now:

- Sports. My ping-pong game improved significantly with sharper vision of the ball and its spin. And in contact sports like basketball and ultimate frisbee, I can move and react with sharper movements without worrying about my glasses falling off.

- Bicycling. I now have the peripheral vision to see traffic behind me with less rotational neck strain and a much quicker glance.

- Roller coasters. Sounds silly, but thrill rides are significantly more enjoyable with sharp vision from the top rather than having to pocket the glasses or worry about them falling off (even with a strap).

- Around the house. I can watch TV lying on my side on a pillow, which never was possible with glasses in the way. I can see in the shower, I can read the bathroom scale, which were times I wouldn't be wearing the glasses.

- Less skin irritation and acne, where the glasses would chafe and hold oil against my face.

It's a serious improvement. You don't realize how much mindspace glasses consume and how many small irritations there were until you're free of them. My vision just always works now and I never have to think about it.

I haven't had LASIK surgery (yet), but I've been wearing glasses or contacts since I was about 6 years old, and there are lots of reasons why I think being glasses/contacts-free would improve my quality of life. Many of them have already been mentioned (seeing in the rain, being able to see clearly in bed), but following Karl from NY, I would add:

- Swimming. You can't really swim with glasses on (unless you have prescription swimming goggles), so you can't see anything in the ocean/pool. If you wear contacts, you have to wear goggles on top of them or risk losing them.

- Camping. I don't really like camping, but one of the big reasons for that is I don't like being away from first-world plumbing and bathrooms because I can't take off, clean, and store my contacts sanitarily. You can carry solution and a case, but it's really nice to have a mirror and a sink and running water.

- Falling asleep in unintended places/at unintended times. I've slept in my contacts a few times, due to being inebriated or just really, really tired. It's terrible to wake up after 6+ hours of sleeping with contacts on.

- Spur-of-the-moment things. If you're a contact-wearer, you can't just decide to stay somewhere other than your home on a whim, unless you always carry solution and a case with you. So if you want to go home from a bar with someone, or take a trip to Vegas after work, or spend the night where you are (not your home) after a sudden blizzard or flood, you have to plan ahead.

Lastly, she made a point to tell me it made her happier because she - like any normal human - didn't want to #### while wearing her glasses, and finally everything wasn't a dull blur while she was having sex.

I thought you meant the other four-letter word - ####. My first reaction was..."yeah that would blow, having to wear glasses on the toilet". Followed quickly by: "wait a minute, why would it?". Followed again by: "Ohhh, I'm an idiot".

Anti-aging clinics dole this stuff out by the bucketful. Bosch's other clients were 40-year-old office workers who wanted to feel and look like they were 25-30. They were injecting themselves with steroids, IGF-1 and all the rest. There's not a gym in the world that doesn't have a couple of guys walking around that make Bonds look like Pee Wee Herman. The amount of plastic surgery going on for no good reason is criminal.

And Bosch, and the other clinics doing this, are almost certainly breaking the law in doing so. Here's the full list of FDA approved uses for HGH:In children, HGH injections are approved for treating short stature of unknown cause as well as poor growth due to a number of medical causes, including:
-Turner's syndrome, a genetic disorder that affects a girl's development.
-Prader-Willi syndrome, an uncommon genetic disorder causing poor muscle tone, low levels of sex hormones, and a constant feeling of hunger.
-Chronic kidney insufficiency.
-HGH deficiency or insufficiency.
-Children born small for gestational age.

In adults, approved uses of HGH include:
-Short bowel syndrome, a condition in which nutrients are not properly absorbed due to severe intestinal disease or the surgical removal of a large portion of the small intestine.
-HGH deficiency due to rare pituitary tumors or their treatment.
-Muscle-wasting disease associated with HIV/AIDS.

Somehow wanting to look 10 years younger is not an approved use for either.

As noted by another poster, TJS has virtually no non-athletic applications. Rather than being morally troubling, that should be comforting to us -- at least we aren't asking these guys to risk long-term impairment for our enjoyment. (Not so sure about torn labrums.)

Well a large part of that, is that it is almost impossible to get that injury, outside of particularly stressful athletic activities. The first paragraph on web MD states that it is mostly performed on athletes, but also sometimes on non-athletes.

You can deal with a torn ACL without surgery as well. Yet I know 2 people, who are decidedly not athletes, who elected to have their knee reconstructed, because they thought it was still worthwhile.

I always bring up that near the end of his career, Clemens was using Vioxx to kill the pain so he could take the mound every 5th day.

Well, I am against the abuse of prescription painkillers. But was Clemens in fact in pain? Would a reasonable doctor have prescribed him those painkillers to deal with that pain outside of baseball? If so, pretending it is exactly the same as steroids is stupid. And I am not even going to get into the stupidity of your opinion on LASIK, which has been thoroughly addressed.

So it's a completely arbitrary and illogical line in the sand that some try to draw.

What? When you try to argue that the law should distinguish between medical interventions that "[do] not simply improve athletic performance, [but] improve quality of life in general", you are trying to "draw a line." That's what the term means. Do you really not understand this?

Somehow wanting to look 10 years younger is not an approved use for either.

Again, you have completely missed the point. Existing medical regulations allow people to have plastic surgery in an attempt to "look 10 years younger". They don't allow people to take HGH to achieve this same goal. This raises the question of why the law draws this distinction and whether it is justified, since plastic surgery complications can be extremely severe whereas the adverse side effects of HGH are either relatively uncommon or still speculative (e.g., increased risk for certain types of cancer).

I've been wearing glasses since I was about 12 years old and have gone over to wearing contacts full time once I left the kitchen 5 years ago. Most of the time glasses weren't a pain for me but after long days or night driving or when it was raining or when I'm coming out of a fridge they can be real annoying. Plus as others have said playing sports or going to an amusement park with glass is a real pain. Contact lenses aren't perfect but they improve my life somewhat. Would like to get LASIK at some point but the only problem for me is that they keep coming out with new procedures so the price of the surgery never really goes down.

- Falling asleep in unintended places/at unintended times. I've slept in my contacts a few times, due to being inebriated or just really, really tired. It's terrible to wake up after 6+ hours of sleeping with contacts on.

BITD contacts were made of hard plastic and very small, only about 3/8" in diameter. Whenever I started to doze off during an all-nighter in college and didn't have my storage case on me, I'd just put them into my mouth. (Believe it or not, with those hard lenses, you didn't have to worry about eye infections if you just rinsed them off with water before putting them back in.)

This worked fine until one night I dozed off and for some weird reason I dreamed that I was chewing on a grape skin, and woke up to realize that I'd just chewed away $300. These were lenses that were built to last for many years, not the cheap throwaways of today.

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I've been wearing glasses since I was about 12 years old and have gone over to wearing contacts full time once I left the kitchen 5 years ago. Most of the time glasses weren't a pain for me but after long days or night driving or when it was raining or when I'm coming out of a fridge they can be real annoying. Plus as others have said playing sports or going to an amusement park with glass is a real pain. Contact lenses aren't perfect but they improve my life somewhat. Would like to get LASIK at some point but the only problem for me is that they keep coming out with new procedures so the price of the surgery never really goes down.

I started wearing glasses at 11, switched to contacts for high school baseball---HUGE improvement---and after going from hard lenses to soft lenses at 40, I got Lasik at 55, because the smoke in pool rooms was irritating the #### out of my eyes with contacts, and going back to glasses was a non-starter.

And after 13+ years, I can say that the "quality of life" gap between Lasik and contacts is even greater than that between glasses and contacts, in part because of what Cooper says about the constrictions contacts put on spontaneity, but also because unless you're fairly young, your eyes just feel so much better without a foreign object in it, especially late in the evening or if you're around smokers. The only downside is that past a certain age (they say it's usually around 40 to 45) you'll need to get a pair of drug store reading glasses for close distance viewing. But for all outdoor or long distance viewing Lasik may be the best $5500 I ever spent.

Note to McCoy: Don't bargain hunt for Lasik. Go with a doctor who's performed tens of thousands of surgeries before he gets to you. Your chances of being butchered by a reputable doctor are virtually zero.

I haven't had LASIK surgery (yet), but I've been wearing glasses or contacts since I was about 6 years old, and there are lots of reasons why I think being glasses/contacts-free would improve my quality of life. Many of them have already been mentioned (seeing in the rain, being able to see clearly in bed), but following Karl from NY, I would add:

- Swimming. You can't really swim with glasses on (unless you have prescription swimming goggles), so you can't see anything in the ocean/pool. If you wear contacts, you have to wear goggles on top of them or risk losing them.

- Camping. I don't really like camping, but one of the big reasons for that is I don't like being away from first-world plumbing and bathrooms because I can't take off, clean, and store my contacts sanitarily. You can carry solution and a case, but it's really nice to have a mirror and a sink and running water.

- Falling asleep in unintended places/at unintended times. I've slept in my contacts a few times, due to being inebriated or just really, really tired. It's terrible to wake up after 6+ hours of sleeping with contacts on.

- Spur-of-the-moment things. If you're a contact-wearer, you can't just decide to stay somewhere other than your home on a whim, unless you always carry solution and a case with you. So if you want to go home from a bar with someone, or take a trip to Vegas after work, or spend the night where you are (not your home) after a sudden blizzard or flood, you have to plan ahead.

But many people today have extended wear lenses, which eliminates these problems.

It's not about the home runs and it's not about performance enhancement. It's about the law.

Most of the banned substances are illegal to use in the US. Others are illegal to use except for certain purposes, baseball not being one of them.

MLB did jack about this until Congress wanted to know why MLB should still have an antitrust exemption when they are celebrating and financially rewarding lawbreakers. THEN MLB did something.

The problems they faced were:

1. In other countries it's not illegal. There was nothing to stop players from going to, say, the Dominican Republic, using these drugs there, then returning. Testing can reveal what someone took, but not where they took it.

2. Some drugs are legal in the US, but serve as masking agents for illegal drugs.

MLB's approach was basically to ban it all. No excuses. Even if you're compliant with the law in every jurisdiction, it doesn't matter. There is a basic presumption of illegality if you are found to have used.

Now, if you want to say Congress was attentive only because of home runs, that's fine by me.

But the distinction between PEDs and surgery in MLB starts with the law. MLB doesn't want a system in which players feel they must break the law in order to have a job or to get paid more.

And testing won't catch the stuff the stuff that's out of your system quickly. Which is why professional cyclists now live under 24*7 scrutiny until the day they retire. Including the requirement to account for their movements and be available for out of competition tests on no notice at any time.

But many people today have extended wear lenses, which eliminates these problems.

Out of curiosity, how long can you wear them safely? Do they ever cloud up? How long do they last? Months or years? And how much do they generally cost? I'm assuming that the vision you get is comparable to Lasik.